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Ethics in Healthcare

Ethics in Healthcare. Meet the Big 8. Aquinas Kant Mill Rawls Aristotle Buber Kohlberg Frankl. Saint Thomas Aquinas (1225-1274). Theory: Natural Law God is rational and created the world rationally. Humans can reason, therefore are capable of choosing good over evil.

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Ethics in Healthcare

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  1. Ethics in Healthcare

  2. Meet the Big 8 • Aquinas • Kant • Mill • Rawls • Aristotle • Buber • Kohlberg • Frankl

  3. Saint Thomas Aquinas (1225-1274) • Theory: Natural Law • God is rational and created the world rationally. • Humans can reason, therefore are capable of choosing good over evil. • Influences: Aristotle and Christian theology • Asked a lot of questions to develop theories • Gift of Free Will • Why do we do things? • The need to listen to conscience.

  4. What is Good? • Humans should strive for the highest good—seeking wisdom and knowing God. • For Aquinas, good preservers life and the human race, allows us to act prudently so we can live in community, and seek the truth

  5. Happiness • Pursuing our passionate appetites such as eating, drinking, physical relations, power. • We are to use restraint in these things, so that we can enjoy them without being ruled by them. • To be ethical, we must allow others to gain their best human potential. • We must practice the cardinal virtues (prudence, temperance, courage, justice).

  6. Stop and Talk • Can you limit health care based on life decisions? • What are the cost factors for the health care system? • What is the healthcare obligation to those who do not make rational choices?

  7. Immanuel Kant (1724-1804) • Theory: deontology (duty-based ethics) • Everything in society has relative value. • The only true good is good will. • All human beings have worth. • People are not just tools to achieve societal or organization goals. • Categorical imperative helps make decisions.

  8. Stop and Talk • Are all people valuable no matter how they contribute to the bottom line? • Why would a pure Kantian practice be practical in healthcare?

  9. John Stuart Mill (1806-1873) • Theory: Utilitarianism produces utility (benefit) and/or avoids harm. • Influential in American healthcare ethics. • People can be a means to an end, but the end must be __________.

  10. Types of Utility • Act Utility • Each decision based on its own merit. • Rule Utility • Consequences help to form rules. • Rules are then used for decisions.

  11. Stop and Talk • What are the limitations of utilitarianism? • How can it help you make decisions? • How can it help you make policies?

  12. John Rawls (1921-2002) • Theories: original position and veil of ignorance. • If the concepts were true, we would create rules to live in a just society. • What is a just society? • These rules would lead to social contract. • Social contract = equal basic rights including protecting those in lesser positions (in your self interest). The advantaged have the responsibility to carry out this mandate.

  13. Stop and Talk • Societies are judged by how it treats the least well off? How would America be judged? • His theories cause ethics concerns in healthcare because they ask for a balance of mission and profit. How do you see this in hospitals?

  14. Aristotle (384 BC – 322 BC) • Virtue Ethics • What makes a good person • Practical wisdom and eudaimonia. • A character trait that you are willing to ACT on • Includes thinking emotions, choices, values • If you have virtue, you will act on it even when it is difficult.

  15. Practical Wisdom or Phronesis • Practical Wisdom means you think about how and why to act. • The ability to decide what is best for a situation. • Rational thought is achieved by experience AND education.

  16. Eudaimonia • Happiness or flourishing. • Only possible with humans. • Living a life devoted to virtues and not just to external rewards such as money or pleasure.

  17. Stop and Talk • What kind of employees do you want to hire? • What are the benefits of eudaimonia?

  18. Martin Buber (1878-1956) • Ethics is about relationships and forms a hierarchy • I-I—person does not exist. • I-IT—people as property. • I-YOU—people are whole and have ideas • I-THOU—highest moral relationship; agape.

  19. Stop and Talk • What would happen if you treated people as I-YOU? I-IT?

  20. Lawrence Kohlberb (1927-1987) • Ethical Development Stage Theory • Pre moral (before moral reasoning) or • Pre Conventional, its about YOU. • Level one—avoid punishment • Level two—personal rewards • Exernally controlled morals (Rules by others) • Level three—please people • Level four—law is obeyed • Principled morals (Rules by higher authority) • Level five—common rights • Level six—universal rights and laws

  21. Stop and Talk • Analyze your own moral stages • What is your role in society's eyes

  22. Victor Frankl (1906-1997) • Search for meaning • You are Mind/Body/Spirit (noös) and unique in the universe. • Finding meaning in life and work is key. • You have choices but with choice comes responsibility. • There is super meaning that knows the answers. Consequence is key to your choices and keeps you from the existential vacuum.

  23. Stop and Talk • Do you accept responsibility for your choices?

  24. Application to Health Care • Think of the theories we have just reviewed. How can we use them in health care? • What does the word ethics mean to you? • How does knowing about the Big 8 help you understand ethics?

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